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General NPI Number Information
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NPI Number | 1144551516
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Entity Type | Individual
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Provider Name | VENUS FORTIN PENULIAR-CHUPUICO RPT
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Gender | Female
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Dates
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Enumeration Date | 01/24/2010
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Last Update Date | 01/24/2010
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Provider Practice Location Address
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Address Line | 1238 COMMERCIAL ST
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City | WARSAW
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State | MO
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Zip | 65355-3157
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Country | US
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Telephone | 660-438-2876
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Fax |
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Provider Business Mailing Address
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Address Line | 611 E OAK ST
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City | CLINTON
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State | MO
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Zip | 64735-1671
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Country | US
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Telephone | 417-396-6371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2005036212
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License Number State | MO
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